Dr Cummings & Partners Also known as Honley Surgery

Updated 3 October 2016

Background to Dr Rawcliffe and Partners

Dr Rawcliffe and Partners is also known locally as Honley Surgery and is located in a semi-rural area at Marsh Gardens, Honley, Holmfirth, West Yorkshire, HD9 6AG. The practice is situated within a purpose built building which has been extended over time to meet patient demand. It has level access, disabled facilities and parking available.

The practice provides services for 7,853 patients and is situated within the Greater Huddersfield Clinical Commissioning group (CCG) and is contracted to provide primary medical services under the terms of a personal medical services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

They offer a range of enhanced services such as childhood immunisations, facilitating timely diagnosis and support for people with dementia and improving patient access on line.

There is a slightly higher than average number of patients aged over 50 and there are fewer patients aged between 15 and 39 than the national average. The national general practice profile shows that the practice population is predominantly white British with only 4% of the practice population from a south Asian or mixed background. Whilst the diversity of the area is changing, within the CCG, white British remains the largest ethnic group.

The practice has four GP partners, one of whom is male and three are female, with one male salaried GP. The practice also employs three part time practice nurses, two health care assistants (HCAs) and two part time advanced nurse practitioners (ANPs) who are all female. The clinical team is supported by a practice manager and a team of administrative staff.

The practice catchment area is classed as being within one of the 20% least deprived areas in England with low unemployment.

The practice reception is open between 7:30 am and 6:00 pm on Mondays, 8:00 am and 6:00 pm Tuesday to Friday with appointments available during these times. The practice offers an extended hours clinic on rotating Tuesdays or Wednesdays until 8:00 pm. Patients can see a GP or a nurse at these times.

When the surgery is closed patients are advised of the NHS 111 service for non –urgent medical advice and are directed to a local service.

The practice is a teaching practice and supports medical students and FY2 placements. (The Foundation Programme is a two-year training programme for doctors who have just graduated from medical school).

At the time of our inspection the practice was in the process of updating their registration of the registered manager and updating the names of the partners of the practice with the Care Quality Commission. This is a requirement of registration.

Updated 3 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rawcliffe and Partners, also known as Honley Surgery on 18 August 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety. Staff were encouraged to report and record significant events and we saw that learning from this was shared with the team.

• Safeguarding was a priority for the practice and we saw evidence that best practice was followed. Staff knew how to recognise the signs of abuse in vulnerable adults and children and any safeguarding concerns were discussed at a multi-disciplinary meeting each month.
• Patients’ needs were assessed and care was planned and delivered following local and national care pathways and National Institute for Health and Care Excellence guidance.
• Services were planned to respond to the needs of the patient population. For example, patients could attend a nurse led anticoagulation clinic for which the practice was a hub. Previously patients had to attend the local hospital which had involved a lengthy bus journey for those patients dependent on public transport.
• Risks to patients were assessed and well managed.
• Patients said they were treated with kindness, compassion and that GPs and nursing staff were good at treating them with care and concern. We saw that urgent appointments were available the same day.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice proactively sought feedback from staff and patients and the virtual Patient Participation Group (PPG), which it acted on.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

The surgery actively supported a charity which it set up 15 years ago to provide transportation for patients to three local GP practices. The Holme Valley Transportation scheme was available to all patients, free of charge that needed this service including older people, young parents and those living in isolated areas. The practice organised regular fundraising events and engaged the local community in the service. Figures showed up to 120 patients used the transport each month who would otherwise struggle to access health services. Whilst we saw that the practice had the capacity to offer home visits, they were aware of the social isolation faced by some patients who preferred to use the transport to visit the practice when they could.

The practice had a dedicated “dosette box team” who liaised with the GPs, pharmacy and the patient to ensure that patients were receiving the medication they required in a way that they could manage. The team would also review patients that no longer needed this service to reduce costs.

The areas where the provider should make improvement are:

The provider should undertake infection prevention and control audits on a regular basis.

The provider should review their arrangements for clinical audit at the practice. Clinical audit should be clearly linked to patient outcomes, monitored for effectiveness and be comprised of two or more cycles to monitor improvements to patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 October 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Outcomes for patients with diabetes were comparable to national and local averages. For example, the percentage of patients with diabetes, on the register, whose cholesterol was within normal limits over the preceding 12 months was 83% compared to the CCG average of 80% and the national average of 81%.
• Longer appointments and home visits were available when needed.
• The practice ran a cardio-vascular clinic which offered less invasive blood tests and reviewed patients with multiple long term conditions at one appointment.
• The practice offered spirometry testing (a simple test used to help diagnose and monitor certain lung conditions), electrocardiograms (ECG, which is a test that can be used to check your heart's rhythm and electrical activity) and 24 hour blood pressure monitoring.
• The practice ran twice weekly Anticoagulation clinics for their own patients and those of neighbouring practices.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care including the community matron and primary care hospital discharge co-ordinators.
• A phlebotomist from the local hospital attended the practice twice a week to take bloods. This reduced the need for patients to attend sit and wait clinics at the local hospital. The health care assistants (HCAs) at the practice were also able to respond to patient needs and take bloods in a timely manner.

Updated 3 October 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances. All attendances at A&E were reviewed weekly and the GP would telephone the patient or make an appointment for them to be reviewed if necessary.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The percentage of women whose notes recorded that a cervical screening test had been performed within the last five years was 84% which was comparable to the CCG average of 85% and the national average of 82%.
• Appointments were available outside of school hours to see the GP or a nurse and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice offered a co-ordinated 6 weeks post-natal mother and baby clinic with the practice nurse and a GP. Open access baby clinics were held every week.
• The practice used a range of popular social media to communicate with their patients and update them of any changes at the surgery.
• A full range of sexual health services was offered at the practice including sexual health screening, general sexual health advice, contraception and emergency contraception. Appointments could be booked in advance or on the day.

Updated 3 October 2016

The practice is rated as outstanding for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice offered a range of services to older people including annual health checks.
• The practice offered medication reviews for patients who take several medicines. These reviews were carried out in the patient’s home if necessary.
• A proactive weekly GP visit was conducted at a nursing home supported by the practice.
• The surgery actively supported a charity which it set up to 15 years ago to provide transportation for patients to three local GP practices. The Holme Valley Transportation scheme was available to all patients, free of charge that needed this service including older people. The practice ran regular fundraising events and engaged the local community in the service. Whilst we saw that the practice had the capacity to offer home visits, they were aware of the social isolation faced by some patients who preferred to use the transport to visit the practice when they could.
• The nursing team visited older people who lived in nursing homes or their own homes to offer them their flu vaccination in the autumn.
• The practice had a dedicated “dosette box team” who liaised with the GPs, pharmacy and the patient to ensure that patients were receiving the medication they required in a way that they could manage. The team would also review patients that no longer needed this service to reduce costs.

Updated 3 October 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services. This included text message reminders for appointments, access to test results and the on line booking of appointments.
• An extended hours clinic was held on alternate Tuesday or Wednesday evenings until 8.00pm when patients could be seen by the GP or a practice nurse. Patients could also access telephone consultations each day with a GP, advanced practitioner, health care assistant or a practice nurse.
• The practice offered a dedicated prescription telephone line where patients could order repeat medications at any time of the day or night.

Updated 3 October 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Data showed that 82% of patients with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 85% and the national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 93% which was better than the CCG average of 88% and the national average of 90%.
• Patients with mental health issues were offered an annual physical health check.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• For patients with dementia who took multiple medications, reviews could be carried out in the persons home and outcomes documented within the individuals care plan.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had attended additional training and were registered as ‘dementia friends’.

Updated 3 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice offered longer appointments, annual health checks and care plans for patients with a learning disability.
• The practice offered a “safe place” to vulnerable people as part of the Kirklees Safe Places Scheme. Staff had undergone training and the practice displayed a poster to inform people that they would offer help and support if necessary.
• The practice had identified a dedicated carers champion and were proactively identifying carers within the patient population. Carers were offered an annual health check and a flu vaccination. There was good information available in the form of leaflets and patients were signposted to which groups to contact for support.
• Two staff at the surgery were dedicated patient liaison officers. Their role was to speak directly to patients, giving advice, support and information to distressed or unhappy patients.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. The safeguarding information included guidance on what to do when vulnerable patients, children or families did not attend for appointments.